Facet Arthritis

What Is Facet Arthritis?

The facet joints connect the posterior elements of the vertebral bodies to one another. The articular surfaces of the facet joints are covered by a layer of smooth cartilage, surrounded by a strong capsule of ligaments, and lubricated by synovial fluid, just like any other joint. The facet joints can also become arthritic and painful causing back pain. The pain and discomfort that is caused by degeneration and arthritis of this part of the spine is called facet arthritis.

What Causes Facet Arthritis?

In most cases, facet arthritis results from a gradual, degenerative aging process. Either structural changes or inflammation can begin the process. As people age, the facet joints may thicken and enlarge. When surfaces of the joint begin to project out from the body, these bone spurs are called osteophytes. When one part of the spine degenerates, it usually places increased stress on other parts of the spine.

What Are The Symptoms Of Facet Arthritis?

Patients with facet arthritis typically will complain of low back pain that is worse with twisting or extension (bending backwards) of the back. The pain can be very well localized or can involve substantial portions of the spine. It does not usually radiate into the buttocks or down the legs, although that can be part of some patient's symptoms. As the facet joints become arthritic, they often develop bone spurs that can decrease the amount of space available for the nerve roots as they exit the spinal canal. This can help to cause spinal stenosis which does cause pain, numbness, and weakness in the buttocks and legs.

What Are Some Non-surgical Treatments For Facet Arthritis?

In the absence of severe or progressive nerve involvement, the doctor may prescribe nonsteroidalanti-inflammatory drugs, such as aspirin, naproxen, ibuprofen, or others to reduce inflammation andrelieve pain. Analgesics, such as acetaminophen, tramadol or narcotics may be prescribed to relieve pain. The doctor may order physical therapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. Some patients may be encouraged to try an exercise program, aquatics or chiropractic. Corticosteroid injections into the facet joints may be performed to reduce inflammation and treat severe pain. If these are successful, some patients may undergo facet rhizotomy with radiofrequency ablation. This procedure use a small electrical probe that destroys the nerve that goes to the facet joint.

When Should Surgery Be Considered?

In some cases, the symptoms of facet arthritis cannot be controlled by nonsurgical treatment. Sometimes the symptoms can be controlled by non-surgical treatment but does not last a sufficient period of time to justify continued efforts at controlling symptoms. Spine surgery might be considered immediately if a patient has numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement. Otherwise, the effectiveness of nonsurgical treatments, the extent of the patient's pain, the patient's overall health status and the patient's preferences may all factor into whether or not to have surgery.

The purpose of surgery for facet arthritis is to remove the painful facet joint, fuse the spine when necessary and relieve any pressure on the spinal cord or nerves. This is done by removing, trimming, or adjusting diseased parts that are causing the pain or pressure on the spinal nerves or canal. The most common surgery for facet arthritis is called a facetectomy. It involves the removal of all or part of the facet joint. A neurosurgeon or orthopaedic spine surgeon may perform a facetectomy. It may or may not be accompanied by fusing vertebrae (fusion). In some cases, hardware may be necessary to enhance fusion and strengthen unstable segments of the spine following decompression surgery. In some limited cases where the facet is placing pressure on the spinal nerves and not causing any other problem, a more limited surgery called a foraminotomy may be performed to just open up the foramen (the hole where the nerve comes out) by shaving back the thickened portions of the facet.